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Peri-operative platelet function testing: The potential for reducing ischaemic and bleeding risks

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
Topic:

Theme Issue
Platelet function testing: From bench to bedside

DOI: http://dx.doi.org/10.1160/TH11-02-0063
Issue: 2011: 106/2 (Aug) pp. 185-387
Pages: 248-252

Peri-operative platelet function testing: The potential for reducing ischaemic and bleeding risks

P. A. Gurbel (1), E. Mahla (2), U. S. Tantry (1)

(1) Sinai Center for Thrombosis Research, Baltimore, Maryland, USA; (2) Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria

Keywords

antiplatelet drugs, platelet pharmacology, atherothrombosis

Summary

The pivotal role of platelet activation and reactivity during atherothrombotic event occurrence associated with acute coronary syndromes (ACS) or percutaneous coronary interventions (PCI) is well established. Numerous translational research studies have established a threshold level of platelet reactivity during dual antiplatelet therapy above which a higher risk for ischaemic event occurrence has been observed. The clinical validity of these threshold values in reducing ischemic event occurrence with modified P2Y12 receptor therapy is currently under investigation in large-scale clinical trials. The association between on-treatment platelet reactivity measured by an ex vivo assay and the occurrence of bleeding events is less established. Currently, there is limited evidence of an association between platelet inhibition and coronary artery bypass grafting (CABG)- related bleeding in patients on clopidogrel therapy indicating that preoperative platelet function monitoring may guide both the timing of elective CABG and the administration of blood products in patients needing surgery. However, in the absence of a large-scale prospective clinical trial, routine platelet function monitoring and modification of timing of surgery based on platelet function monitoring are currently not recommended.

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